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Friday, July 29, 2016

Pelvic Exams During Routine Ob/Gyn Visits

What does the evidence say?
The USPSTF did their first-ever evidence review on routine pelvic exams and found no
studies evaluating the benefit of pelvic exam screening on all-cause
mortality, disease-specific morbidity or mortality, or quality of life.The
task force concluded that there isn't enough evidence to recommend
screening pelvic exams in asymptomatic women for conditions other than
cervical cancer screening, gonorrhea, and chlamydia. And last year, the
American College of Physicians (ACP) and the American Academy of Family
Physicians (AAFP) both released guidelines advising against screening
pelvic exams in asymptomatic, nonpregnant adult women. According to the
ACP, routine pelvic exams aren't useful in screening for malignancies
other than cervical cancer, may generate unnecessary evaluation and
surgery, and can cause discomfort in women, leading them to forego
gynecologic care.[1,2]Who defends this practice?
The American College of Obstetricians and
Gynecologists (ACOG) recommends annual pelvic examinations for patients
21 years of age or older. However, in a recent statement, ACOG president
Thomas Gellhaus, MD, said that the society is reviewing the USPSTF
recommendations and that the "limitations of the internal pelvic
examination for screening should be recognized."[3]
According to the statement, the women most likely to benefit from
pelvic exams are those with possible genital tract problems, menstrual
disorders, vaginal discharge, incontinence, infertility, or pelvic pain.

What's actually being practiced?
Most ob/gyns (98.4%) and general
practitioners (89.5%) said they perform pelvic examinations during
well-woman visits, according to a 2011 survey.[4]Is there a middle ground?
Medscape expert commentator Andrew M. Kaunitz, MD, explained
that while pelvic exams are not a good way to detect ovarian cancer,
they are effective for picking up other irregularities, like pelvic
prolapse and cervical polyps. He recently said
that he continues to offer them to patients during well-woman visits,
but for symptom-free patients in their 20s, he only performs pelvic
examinations when indicated for cervical cancer screening.

Do you believe that pelvic exams should continue to be done routinely in asymptomatic patients?

Do you believe that pelvic exams should continue to be done routinely in asymptomatic patients? (see link for up to date survey responses)